Pediatric Research

IntroductionBronchopulmonary dysplasia (BPD) remains a major complication among extremely low gestational age (ELGA) infants, with long-term respiratory and neurodevelopmental consequences. Despite advances in neonatal care, effective therapies to prevent BPD are lacking. Mesenchymal stromal cells (MSC), particularly those derived from umbilical cord (UC-MSC), offer promise due to their pleiotropic effects. Preclinical and early-phase clinical studies have demonstrated safety and potential effic...

ObjectiveTo determine whether the use of nasal, high-frequency percussive ventilation (nHFPV) to manage neonatal respiratory distress decreases the regional cerebral oxygen saturation (rScO2) below that afforded by nasal continuous positive airway pressure (nCPAP). DesignMonocentric, prospective, randomized, monocentric, open-label, non-inferiority crossover trial. PatientsNewborns of gestational age (GA) [≥] 33 weeks exhibiting persistent respiratory distress after 10 min of life (Silverma...

Objective(s)To determine the causal relationship between exposure to early hyperoxaemia and death/disability in infants with hypoxic-ischemic encephalopathy (HIE). Study designWe analyzed data from the Infant Cooling Evaluation (ICE) trial that enrolled newborns [≥]35 weeks gestation with moderate-severe HIE, randomly allocated to hypothermia or normothermia. The primary outcome was death or major sensorineural disability at 2 years. We included infants with arterial pO2 measured within 2 h ...

ImportancePreterm infants are at high-risk of developing brain injury. Near-infrared spectroscopy (NIRS) offers the ability to measure cerebral oxygenation, potentially reducing brain injury. What remains unknown is the impact of using a standardized treatment guideline combined with a single NIRS device manufacturer and neonatal sensor on cerebral oxygenation, which has not been previously examined. ObjectiveTo determine whether cerebral NIRS monitoring with a dedicated treatment guideline imp...

ImportanceIn randomized trials, early prophylactic low-dose hydrocortisone improved survival without bronchopulmonary dysplasia (BPD) and had few adverse effects in extremely preterm infants. Large scale implementation data are needed to estimate effect size and safety. ObjectiveTo examine the association between early prophylactic hydrocortisone and survival without BPD at 36 weeks postmenstrual age in extremely preterm infants in Sweden after implementation, and to assess the safety of this t...

BackgroundCord-clamping strategies may modify blood pressure (BP) and cerebral tissue oxygen saturation (rStO2) immediately after birth. MethodsWe conducted a sub-study nested within the Baby-Directed Umbilical Cord-Clamping trial. Infants [≥]32+0 weeks gestation assessed as requiring resuscitation were randomly allocated to either physiologically-based cord clamping (PBCC), where resuscitation commenced prior to umbilical cord clamping, or standard care where cord clamping occurred early (E...

Invasive respiratory interventions save infant lives yet, have negative consequences for their general health and neurodevelopment. Tools that can both accurately summarize the intensity of ventilation needed during an infants stay in the NICU and be used to make predictions about their future health and neurodevelopmental outcomes are currently lacking. Here we present the Prognostic Respiratory Intensity Scoring Metric (PRISM) as an accurate, summative tool of respiratory support needs in hosp...

BackgroundApnoea is a common respiratory complication in preterm neonates, leading to substantial changes in physiology. We conducted this systematic review and meta-analysis to examine the relationship between apnoea duration and changes in physiology in preterm neonates, and to identify factors that modulate this relationship. MethodsWe searched Medline, EMBASE, PsycINFO, and Cochrane Central Register of Controlled Trials databases and included primary empirical studies examining the relation...

AO_SCPLOWBSTRACTC_SCPLOWLarge volume surfactant administration in premature infants less than 35 weeks using minimally invasive surfactant therapy (MIST). BackgroundSurfactant in small volume preparations can be successfully administered to premature infants using a narrow-bore vascular catheter inserted into the trachea under direct vision. It was not known if surfactant in large volume preparations could be administered effectively to spontaneously breathing premature infants while maintainin...

ObjectiveProstaglandin inhibitors (PGI) are used to treat patent ductus arteriosus (PDA) of prematurity. PGIs often cause decrease in urine output (UO), the mechanism of which is like that of PDA closure. We hypothesized that PGI-induced decrease in UO predicts PDA closure. DesignProspective, cohort SettingLevel III NICU MethodsWe prospectively enrolled 40 preterm neonates ([≤]34 weeks gestation) with clinical and/or echocardiographic hemodynamically significant PDA (hsPDA), being treated ...

BackgroundPersistent pulmonary hypertension of the newborn (PPHN) is a cause of neonatal hypoxic respiratory failure due to the failed transition of the pulmonary vasculature after birth. Mechanisms of disease are unknown, but we hypothesize they are directly related to insults in the intrauterine environment. The objective was to describe and compare placentas of PPHN infants to understand significant preceding factors from the maternal-fetal environment. MethodsWe conducted a case-control stu...

BACKGROUNDExtremely premature infants are treated with acetaminophen (APAP) for discomfort and patent ductus arteriosus. A recent study found an association between APAP metabolite levels in mothers breast milk and the diagnoses of both bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in their infants. METHODSUrine samples from 314 infants <29 weeks gestation in the TOLSURF and PROP studies were analyzed by untargeted UHPLC:MS/MS. We performed multivariate logistic regressi...

Bi-level non-invasive ventilation (BiPAP) can be used as a step-up from continuous positive airway pressure (CPAP) in preterm neonates to reduce the amount of time spent mechanically ventilated. Prolonged mechanical ventilation is associated with increased morbidity and mortality. MEDLINE was searched using the terms CPAP and BiPAP. Four studies reported a significant reduction in the need for mechanical ventilation when applying BiPAP compared with CPAP. Two studies reported no significant bene...

Background and ObjectivesNeonatal hypothermia has been shown to be commonly detected among late preterm and term infants. In preterm and very low birth weight infants, hypothermia is associated with increased morbidity and mortality. Little is known about the clinical interventions and outcomes in hypothermic late preterm and term infants. This study fills this gap in the evidence. MethodsSingle-center retrospective cohort study using electronic health record data on infants [&ge;]35 weeks gest...

ObjectiveTo determine the regional ventilation characteristics during non-invasive ventilation in stable preterm infants. The secondary aims were to explore the relationship between indicators of ventilation homogeneity and other clinical measures of respiratory status. DesignProspective observational study. SettingTwo tertiary neonatal intensive care units. PatientsForty stable preterm infants born <30 weeks gestation receiving either CPAP (n=32) or nHF(n=8) if <36 weeks corrected gestation,...

The lower-airway microbiome may influence the pathogenesis of lung disease. Bronchopulmonary dysplasia (BPD) is a serious morbidity associated with preterm birth that may be influenced by lower-airway microbial or metabolic alterations. This study used16S rRNA gene sequencing, metabolomic analyses, and the Kyoto Encyclopedia of Genes and Genomes (KEGG) database to investigate the lower-airway microbiome and metabolome in a cohort of preterm infants with mild, moderate, or severe BPD or no BPD. D...

Preterm infants are at high risk for systemic inflammatory disorders, including sepsis, meningitis, bronchopulmonary dysplasia, and necrotizing enterocolitis (NEC). The developing brain of the premature newborn is especially susceptible to the cascade of inflammatory mediators elaborated in these conditions that cross the blood-brain barrier. NEC, a severe and potentially fatal condition of the gut that occurs in premature newborns, is a prime example of how an inflammatory reaction, perhaps ini...

ObjectiveTo test the hypothesis that remote ischemic conditioning (RIC) is safe and feasible as an adjunctive neuroprotective treatment in neonates with hypoxic-ischemic encephalopathy (HIE) during therapeutic hypothermia (TH). Study designIn this prospective, randomized, safety and dose escalation study in 32 neonates with HIE undergoing TH at a single quaternary referral NICU, four cohorts of consecutive patients received escalating therapy as follows: the first cohort of four patients receiv...

ImportanceBronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH) are leading causes of morbidity and mortality in premature infants. ObjectiveTo determine whether images obtained as part of retinopathy of prematurity (ROP) screening might contain features associated with BPD and PH in infants, and whether a multi-modal model integrating imaging features with demographic risk factors might outperform a model based on demographic risk alone. DesignA deep learning model was used to stud...

ObjectiveSynchronising positive pressure inflations with an infants own breathing is considered lung protective, but the ventilation patterns within the infant lung during synchronous and asynchronous inflations are unknown. The aim of this study was to describe the regional distribution patterns of tidal ventilation within the lung during mechanical ventilation that is synchronous or asynchronous with an infants own breathing effort. MethodsIntubated infants receiving synchronised mechanical v...